BackgroundTropical and zoonotic diseases are major problems in developing countries like Ecuador. Poorly designed houses, the high proportion of isolated indigenous population and under developed infrastructure represent a fertile environment for vectors to proliferate. Control campaigns in Ecuador over the years have had varying success, depending on the disease and vectors targeted.AimsIn our study we analyse the current situation of some neglected diseases in Ecuador and the efficiency of the control campaigns (by measuring changes in numbers of cases reported) that the Ecuadorian government has been running to limit the spread of these infectious and parasitic diseases.ResultsOur study reveals that Brucellosis, Chagas Disease, Rabies and Onchocerciasis have been controlled, but small outbreaks are still detected in endemic areas. Leptospirosis and Echinococcosis have been increasing steadily in recent years in Ecuador since the first records. The same increase has been reported world-wide also. Better diagnosis has resulted in a higher number of cases being identified, particularly with regard to the linking of outdoor activities and contact with farm animals as contributing vectors. Improvements in diagnosis are due to regular professional training, implementation of automatized systems, establishing diagnosis protocols and the creation of an epidemiological vigilance network that acts as soon as a case is reported.ConclusionControl campaigns performed in Ecuador have been successful in recent years, although natural phenomena limit their efficiency. Leptospirosis and Echinococcosis infections remain a growing problem in Ecuador as it is worldwide.
The preventive measures helped to reduce the impact of the 1998 cholera epidemic in Ecuador, in terms of both incidence and the case fatality rate. Given the overall sensitivity of the strains to the antimicrobial drugs, there is no reason to change the current treatment regimens in the country. Taking into account the frequency of natural disasters in Ecuador and the relation that they have to the reappearance of cholera, interventions should be designed that make it possible to prevent and control the reappearance of the disease and its spread to the most vulnerable provinces of the central Sierra mountainous region and the eastern part of the country.
Objetivo. Conocer el uso de la evaluación de tecnologías sanitarias (ETS) en la toma de decisiones del Ministerio de Salud Pública (MSP) del Ecuador para la compra de medicamentos que no se encuentran en el Cuadro Nacional de Medicamentos Básicos (CNMB). Métodos. Con la información de las bases de datos de la Dirección de Inteligencia de la Salud (DIS) y la Dirección Nacional de Medicamentos y Dispositivos Médicos (DNMDM), se compararon las decisiones tomadas por ambas instancias, para conocer el uso y la congruencia de los informes de ETS en las decisiones de compra de los medicamentos no incluidos en el CNMB. Resultados Entre 2012 y 2015, se han elaborado 227 informes, de los cuales 87 corresponden a medicamentos, 36 a dispositivos, 29 a procedimientos médicos, 34 a programas sanitarios, y 41 a otras tecnologías médicas. De los informes de medicamentos, 59 fueron solicitados por la DNM. La concordancia entre las decisiones tomadas por las dos direcciones que participan en el proceso alcanzó 80%. Conclusiones. La ETS se inició en el MSP en 2012 a través de la DIS. Considerando que la mayoría de informes evalúan medicamentos, es indispensable que se desarrollen informes para otros tipos de tecnologías médicas y que se difunda al máximo su desarrollo y uso. A pesar de que el nivel de concordancia entre las decisiones es elevado, es importante seguir mejorando el alcance y la calidad de los informes, así como monitorizar la incorporación y difusión de las tecnologías autorizadas y financiadas para conocer la efectividad y el impacto de la ETS en Ecuador.
Summary Background Helicobacter pylori is the main microorganism causing gastrointestinal diseases, such as chronic gastritis, peptic ulcer, MALT lymphoma, among others. The presence of the s1/m1 genotype of the vacA gene and EPIYA phosphorylation motifs of the cagA gene have been linked to the production of prolonged gastric inflammation. This study determines the presence of these virulence genotypes and their relationship with atrophic gastritis. Methods We included 231 patients with a history of dyspepsia undergoing upper gastrointestinal endoscopy. Samples of gastric tissue were taken to establish, through molecular techniques, the presence of H. pylori by amplifying the ureA and flaA2 housekeeping genes; in addition, the alleles of signal (s) and of the middle region (m) present in the vacA gene were amplified; and by sequencing the repeating patterns of the tyrosine phosphorylation motifs within the Glu-Pro-Ile-Tyr-Ala (EPIYA) motifs of the cagA gene were also amplified. A chi-square test was performed in order to establish the relationship between the virulence genes and the degrees of gastric injury. Results A total of (91/231) samples were positive for H. pylori, of which (57/91) amplified the cagA gene and (66/91) the vacA gene. 81.8% (54/66) of the positive samples for the vacA gene showed the combination of the s1/m1 alleles, associated mostly with atrophic gastritis (AG). The most frequent EPIYA motifs were ABC and ABCC, with 54.4% (31/57) and 40.4% (23/57) respectively. A relation of the genes with AG and its injury severity with a p>0.05 value was observed. The cagA +/vacA s1/m1+/EPIYA ABC pattern is found in most samples. A p=0.02 relationship was found between the presence of the vacA gene and the cagA gene. Conclusions The results show a higher proportion of gastric atrophy in patients infected with H. pylori. The sum of the pathogenicity factors such as the cagA+/vacA s1/m1+/EPIYA ABCC genotype increases the virulence potential of the microorganism, suggesting that the coexistence of these genes could result in an increase in the severity of the progression of inflammation that leads to precancerous lesions.
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